US veterans administration diabetes risk (VADR) national cohort: cohort profile

• Published in: BMJ open Vol. 10; no. 12; p. e039489
• Main Authors: Avramovic, Sanja, Alemi, Farrokh, Kanchi, Rania, Lopez, Priscilla M, Hayes, Richard B, Thorpe, Lorna E, Schwartz, Mark D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 04-12-2020; BMJ Publishing Group
• Series: Cohort profile
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Collaboration; Comorbidity; COVID-19; Diabetes; Diabetes and Endocrinology; Diabetes Mellitus, Type 2 - epidemiology; Disease prevention; Electronic health records; Epidemiology; Female; Humans; Male; Medical laboratories; Middle Aged; Mortality; Overweight; Patients; Population; Primary care; Retrospective Studies; United States - epidemiology; United States Department of Veterans Affairs; Variables; Veterans; Young Adult; United States; United States > US; epidemiology; general diabetes; health informatics
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-039489

PurposeThe veterans administration diabetes risk (VADR) cohort facilitates studies on temporal and geographic patterns of pre-diabetes and diabetes, as well as targeted studies of their predictors. The cohort provides an infrastructure for examination of novel individual and community-level risk factors for diabetes and their consequences among veterans. This cohort also establishes a baseline against which to assess the impact of national or regional strategies to prevent diabetes in veterans.ParticipantsThe VADR cohort includes all 6 082 018 veterans in the USA enrolled in the veteran administration (VA) for primary care who were diabetes-free as of 1 January 2008 and who had at least two diabetes-free visits to a VA primary care service at least 30 days apart within any 5-year period since 1 January 2003, or veterans subsequently enrolled and were diabetes-free at cohort entry through 31 December 2016. Cohort subjects were followed from the date of cohort entry until censure defined as date of incident diabetes, loss to follow-up of 2 years, death or until 31 December 2018.Findings to dateThe incidence rate of type 2 diabetes in this cohort of over 6 million veterans followed for a median of 5.5 years (over 35 million person-years (PY)) was 26 per 1000 PY. During the study period, 8.5% of the cohort were lost to follow-up and 17.7% died. Many demographic, comorbidity and other clinical variables were more prevalent among patients with incident diabetes.Future plansThis cohort will be used to study community-level risk factors for diabetes, such as attributes of the food environment and neighbourhood socioeconomic status via geospatial linkage to residence address information.